Giving people at high risk for type 2 diabetes intensive diet and exercise counselling can result in sustained lifestyle changes and a reduction in diabetes incidence, even after active counselling ceases, according to the extended follow-up of the Finnish Diabetes Prevention Study (FDPS) published in this week's Lancet.
Around 50% of people with impaired glucose tolerance will develop diabetes during 10 years when no active intervention is applied. In the original FDPS study, overweight, middle-aged people with impaired glucose tolerance were randomly assigned to an intensive lifestyle intervention or control group. The intervention group were given detailed and individualised counselling to achieve lifestyle goals (weight loss, decreased intake of fat and saturated fat, increased fibre intake, and moderately intense physical activity 30 min per day or more). After 4 years of active counselling, the intervention group achieved a 58% reduction in relative risk of type 2 diabetes compared with the control group.
The extended follow-up of the FDPS study assessed the extent to which the originally-achieved lifestyle changes and risk reduction remained after discontinuation of active counselling. Jaana Lindström (National Public Health Institute, Helsinki, Finland) and colleagues found that beneficial lifestyle changes achieved by participants in the intervention group were maintained after the discontinuation of the intervention, with a 36% reduction in relative risk. The overall risk reduction was related to the success in achieving the intervention goals of weight loss, reduced intake of total and saturated fat, and increased physical activity and intake of dietary fibre. The study (with a median follow-up of 3 years after active counselling) shows that a marked difference in the cumulative incidence of diabetes can be sustained after the discontinuation of active counselling.
Jaakko Tuomilehto, the other principal investigator of the Finnish Diabetes Prevention Study states: "From a public health point of view there is an important message: an intensive lifestyle intervention lasting for a limited time can yield long-term benefits in reducing the risk of type 2 diabetes in high-risk individuals…Although a lifestyle intervention alone, even if successful, does not necessarily prevent type 2 diabetes in all individuals, it will still postpone the onset of the disease. Even delaying the onset of diabetes can have a substantial effect on subsequent morbidity, and therefore on the cost-effectiveness of diabetes prevention".
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Contact: Jaana Lindström, Diabetes Unit, Department of Health Promotion and Chronic Disease Prevention, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland. T) 00358 947448635 email@example.com
Jaakko Tuomilehto, Diabetes Unit, Department of Health Promotion and Chronic Disease Prevention, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland. T) 00358 405016316 firstname.lastname@example.org
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